GPs can advise patients that it does not matter if they take their blood pressure medication in the morning or evening, say researchers who analysed the pros and cons across five trials.
After a meta-analysis of studies that included almost 47,000 patients presented at this year’s European Society of Cardiology Congress, researchers concluded that it is best for patients to taking the medication when they are most likely to remember it.
Many trials have looked at this issue but have produced mixed results, the Canadian team said.
But combining the data from the studies showed that evening administration of blood pressure lowering medications did not reduce the risk of cardiovascular events or death compared with morning administration.
The studies included population of frail elderly patients and those being looked after in nursing homes.
There was also no difference in all-cause mortality for evening and morning dosing, the researchers noted.
Similarly, all other secondary endpoints were not affected by which end of the day a patient took their medicine, which included the risk of fractures, glaucoma events and cognitive events.
Study leader, Professor Ricky Turgeon from the University of British Columbia, Vancouver, Canada said: ‘Results from the meta-analysis provide conclusive evidence that there is no difference between evening and morning dosing.
‘Patients should take their once-daily BP-lowering medications at whatever time best suits their preferences and circumstances.’
Another researcher presenting results from two of the trials included in the meta-analysis said in one of their studies in more than 3,000 patients with an average age of 67 years, 9.7% of participants in the bedtime group and 10.3% in the morning group had a major cardiovascular event over four years of follow up.
There were no differences in safety outcomes and all-cause hospitalisation or emergency department visits and safety outcomes between the groups.
In the other smaller study of frail elderly patients in a nursing home there was also no difference for the most part except for unplanned hospital admissions or trips to the emergency department which favoured the bedtime group.
Study leader, Professor Scott Garrison from the University of Alberta, Edmonton, Canada said: ‘We found bedtime versus morning administration to provide no difference in major cardiovascular events, nor in potential hypotensive, visual, cognitive or other safety events in a general population and importantly, in frail older patients, a subgroup who are generally excluded from clinical trials.
‘We can now dismiss the treatment timing as being important and advise patients to take their BP medication when they are least likely to forget.’
It comes as UK experts warned that women are underdiagnosed and undertreated in all areas of cardiovascular disease, with conventional risk factors, such as high blood pressure and high cholesterol often not treated as promptly or as appropriately as they are in men.
